It's Only A Five-Step Job

I see this sign everyday. It is posted in one of the staff toilets on the medical ward at the hospital where I am doing my medicine rotation.

It only takes five-steps!? And with illustrated instructions!! To change a roll of toilet paper? I wonder how many toilet-paper-roll-changing mishaps it took for someone to take the time to make and post these instructions. But it gets better. Someone else must have thought, “Five steps? That’s too complicated. I’ll simplify things a bit,” and wrote down the “Alternative Directions” next to the printed instructions.

Every time I look at it, I feel like I am reading a manual for defusing bombs. Okay, maybe not, but this is definitely the first time I’ve seen a toilet paper roll holder that needs an owner’s manual.

~~~~~~~~~~

Tonight’s dinner: herbed chicken risotto with green beans, and a salad.

Might Have Been, Could Have Been

I am currently reading Fresh-Air Fiend by Paul Theroux, one of my favorite non-fiction and travel writers. Fresh-Air Fiend is a collection of short stories Theroux has written between 1985 and 2000.

In one of the stories, Theroux recounts his experience as a Peace Corps volunteer in Malawi in the 1960s. As I am reading it, I suddenly remember that I had toyed with the idea of joining the Peace Corps seven years ago. It was a year after I finished college; I was living in Washington, DC, and had a full-time job. Having just been rejected by all the medical schools I applied to around the country, I was asking myself, “What next?” At the time, the adventurous side of me and the conventional side of me were fighting a battle.

It might have been a poster I saw on the street, it might have been something I had in the back of my head all along, or it might have been just something I came across on the internet at the time, I decided to look into the Peace Corps as the next step. I even went to one of their information sessions, which, replete with tales from an enthusiastic volunteer who had just returned from Vladivostok, had the quality of an infomercial at 2 a.m. My interest was piqued nonetheless. I continued to gather information and looked online at discussion forums about the Peace Corps. So the adventurous side of me was gaining an upper hand.

The conventional side of me, not to be outdone, took me to look at PhD and masters programs at graduate schools. I contacted a few professors and flew to a couple of the school to check them out. What they were doing were interesting stuff: things like tissue engineering and research on exercise in microgravity; but none of them made me slap my forehead and say, “Ah-hah! That’s what I want to do!” I returned home feeling ambivalent about what I had seen. Then one day, I heard about a part-time masters program at Johns Hopkins University and decided to drive to their open house after work. And here, the conventional side of me caught up to the adventurous side of me, then passed it. I decided to start the part-time masters program in biomedical engineering at Hopkins.

And abruptly, Peace Corps fell to the wayside. The glossy brochures and the application packet sat in a pile, forgotten, and when I moved house, went to the dumpster with the rest of the garbage. Not long after that, I’d even forgotten that I gave the Peace Corps serious consideration when I was in the crossroads of life in my early twenties. Looking back, I can see that of course the conventional side of me won – it had society and all the cultural weight behind it. The giant arrow painted on the road of life that says, “This way to happiness” – the non-stop conditioning since childhood by both the Chinese and American cultures – made it easy to follow it and assume it to be correct but difficult to see if there were any alternatives. I had gone back to following the giant arrow after veering ever so slightly down a side trail. This is not to say I regret going to grad school. To the contrary, I am glad I did. I am where I am today partly because I chose that path then.

After two years of grad school and full-time work, I asked myself again, “What next?” I could not find an answer. I had the inevitable burn-out at the time. It did not happen overnight. Rather, the feeling had been brewing steadily toward the end of the two years. Graduation was more like a valve that suddenly let out all the steam. I quit my job, sold or gave away most of my worldly possessions, packed my car, and drove back to California. The adventurous side of me had finally taken revenge. What followed was two years of wandering, on and off, in unfamiliar and remote parts of the world. It was one of those “finding oneself” kind of trip, as clichéd as it sounds. I lived out of a backpack and slept in countless nameless hostels and cheap hotels, I ate street food, I took the cheapest public transport I could find. Materially, it was the poorest I’d been, physically, it was the most uncomfortable I’d felt, but it was the period of time when I felt the most alive. Maybe it was the adventurous side of me saying, “See, you should’ve listen to me last time.”

Looking back, I wonder what would have happened if I had listened to the adventurous side of me earlier and joined the Peace Corps instead. I would have learned another language, I would have been sent to some out-of-the-way community in some obscure country to teach or to help set up a community clinic or help in whatever project, I would have been the farthest away from physical comfort and what was familiar. And I would have loved it. That experienced would definitely have changed my life and my life’s trajectory, as it did Theroux’s. I could have settled down somewhere, I could have gone on to other professions, I could have become a constant nomad who incessantly roams the world for the next patch of pasture, I could have…

Instead, I ended up studying medicine in Australia. It was the result of a series of decision-making since high school without looking too far into the future. And it seems to have worked incredibly well for me. Now, the adventurous side of me and the conventional side of me are not fighting a battle, but are playing complementary roles to each other. My rumination on “what if…” is an exercise of imagination on the outcome of a different path I might have taken in life and a reflection of the fact that every choice I make today, no matter how minute it seems at the time, will have an effect on the options I will have in the future. I don’t think I would be any happier now had I chosen to join the Peace Corps seven years ago, nor am I any less happy now for having decided to go to grad school instead. I have absolutely no regrets on any of the life-changing decisions I have made. Dumb luck? Perhaps. But maybe a dash of a sense of adventure, a pinch of embracing the unknown, and a heap of travelers’ optimism all had something to do with it too.

Not the Sharpest Knife

With two weeks of the rotation over, I am finding myself getting less stressed out by not being able to answer the impromptu quizzes thrown my way on a daily basis. I must be getting used to it. On a good day, I may be able to answer half the questions. Sometimes when my rotation partner and I get grilled together, it really takes the pressure off, even if the other person is just standing there for moral support. Other times, I am give a reprieve and get sent to do some practical things like putting in cannulas in patients’ arms and taking bloods. My fine motor skills are leaps and bounds better than my ability for memory recall. Find a vein in a frail and dehydrated old lady with paper-thin skin big enough for a medium gauge cannula? No problem, I’ll give it a go. List the causes of pleural effusion? Out of the dozens of causes, I’m stuck after listing four. If the career of a physician is predicated on the ability of memorizing long lists, I may have better luck at surgery where manual dexterity counts for something.

Post Mortem

Eight o’clock, my rotation partner and I walk through the green doors. In front of us, the body of an old man is perched on top of a stainless steel cart. Next to the cart is a sink with a spray hose and a stainless steel bench with a cutting board. To the right is a bench with various sharp tools designed to cut through any organic material. The man on the cart died suddenly last week at home. Today the pathologist is going to perform a autopsy and try to find out the cause of death. In Queensland, all autopsies have to be witnessed by the police, so two police officers are also present.

In walks the pathologist. We exchange greetings and he starts working. Wielding a scalpel, he expertly makes an incision from the man’s jawline, down his neck, through the middle of his chest and abdomen, all the way through to the pubis. As he peels back the chest tissues and abdominal wall, the room is immediately permeated with the smell of three days of decomposition, despite the refrigeration. I look around: the smell does not even register with the pathologist, my rotation partner and the police officers start breathing through their mouths. Luckily for me, I am not bothered by the smell. Having peeled back the man’s chest, the pathologist takes a bolt cutter and snaps the ribs one by one until he can lift up the whole front rib cage off the chest like popping the top off a tin can. Next, he frees all the internal organs from the chest and abdominal cavities, slices the tongue from the mouth through the chin, and in one fell swoop, picks up the whole collection of internal organs from tongue to anus and everything in between and lays it down on the bench. The pathologist’s assistant picks up the oscillating saw and goes to town on the skull. In no time, the brain, covered in its fine web of arteries, is presented to the pathologist.

Each organ is weighed, catalogued, sliced, and examined for abnormalities. In the mean time, the pathologist’s assistant sews up the body, leaving a small opening in the abdomen into which he puts a plastic bag. All the chopped up organs are returned to the body into the bag, like so much table scrap being swept down the garbage disposal. The whole procedure is cold and clinical, without any emotional attachment. The person on the table was someone’s father, someone’s husband, someone’s grandfather; but in here, he is just a body whose cause of death the pathologist is trying to determine.

Toward the end of the autopsy, the door to the room swings open. Another body is brought in on a steel cart. “Suicide by hanging,” announces one of the wardies, pointing to the noose still around his neck. The pathologist’s assistant takes the spray hose and cleans off the ants still crawling on the body, then pushes him into the morgue. “We’ll do a post mortem on him later to make sure it was a suicide and not a homicide,” says the pathologist.

With that, the autopsy comes to an end. We thank the pathologist and head to the ward.

Back to the Grind

I am scared.

Today was the first day of the last, and the toughest, rotation this year: internal medicine. Ward round started in the intensive care unit, where I met the consultant I would be attached to for the next four weeks. Immediately, I found myself struggling to answer the questions he threw at me as we saw each patient: chest x-ray interpretation, causes, investigations, and treatments for secondary hypertension, community-acquired pneumonia, and heart failure. Standing in front of the consultant to my left, a senior medical officer (SMO) and a principal house officer (PHO) to my right, I tried to wrestle my brain back from the beaches of Fraser Island as steam started to build up under my collar. It was like playing dodge ball while being chained to a fence post. Two hours later and satisfied that I got a taste of what was to come in the next eight weeks, the consultant left; my battered body sat in a heap on the floor. I picked myself up and finished ward round with the SMO and the PHO.

I finished the day with a long list of things to look up: too much information to learn, too little space in brain.